Histological changes in odontogenic parakeratinized keratocysts treated with marsupialization followed by enucleation

Abstract

Background The purpose of this study was to evaluate whether marsupialization treatment induces changes in the histology of odontogenic keratocyst epithelium and to compare our experience with the literature. Material and Methods A retrospective revision of histological samples was performed. 5 patients with odontogenic keratocyst treated with marsupialization follow by enucleation were selected. Histologic evaluation analyzed the changes in the keratocyst epithelium after marsupialization in terms of type of keratinization, thickness of the epithelium and connective tissue, the presence of acanthosis, the presence and grade of fibrosis, the type and grade of inflammation and the presence and number of mitotic figures and daughter cysts. Results In our case series, a variation of para-keratinized into ortho-keratinized keratocyst was found in one case, and no significant increases were observed in the epithelium and capsule thickness, or even in the level of inflammation. However, we observed an increase in fibrosis and qualitative changes in inflammation type. Conclusions Minor and major histological changes were associated with reduction in cyst volume, which resulted in a simpler and less invasive cystic enucleation after marsupialization. Key words: Keratocyst, marsupialization, enucleation, histology, histological changes.

A Rare Case of Orthokeratinized Odontogenic Cyst (OOC) in the Posterior Mandible of a Young Adult 18-Year-Old Boy

“…In the past years, different natures have been attributed to it. First, until 2005, it was considered an odontogenic cyst in the WHO category, but due to its high invasion and significant recurrence rate, and its connection with the PTCH gene mutation, during the years 2005 to 2017, it was classified as an odontogenic tumor and again in 2017, it returned to the category of cystic lesions due to insufficient evidence of being a tumor 1 , 7 , 8 .…”

“…Although high recurrence is a common feature of OKC 1 , 2 , 4 - 6 , 8 , 10 - 12 ; the recurrence rate of OOC is low 5 , 9 - 13 and there is no need for invasive methods for treatment, and OOC can be treated with conservative methods, resulting in fewer and undesirable complications for the patient 11 .…”

Conservative treatment of mural unicystic ameloblastoma with posterior rehabilitation by implants: A dilemma in oral surgery

“…By contrast, some authors have discussed the clinical effectiveness of marsupialization/ decompression in the treatment of aggressive odontogenic lesions. 10,11 For instance, Consolo et al 10 through analyses of different histological sections of aggressive odontogenic keratocysts identified notorious changes in the cases treated with marsupialization, including cystic volume reduction due to the decrease in the proliferative activity of the odontogenic epithelium and, consequently, squamous cell differentiation and occurrence of fibrosis.…”